Transformation. It is a word that’s rapidly becoming synonymous with any multitude of industry sectors worldwide. And while any transformation represents a game-changing journey for a business and its employees, few have the potential to be as significant as that which Partners Behavioral Health Management is undergoing. The North Carolina-based managed care organisation (MCO), established around seven years ago, is currently in the midst of a digital transformation journey that has the potential to change how healthcare in the United States is defined and paid for.
It is, confesses Chief Information Officer Jamie Gianna, both an “exciting and scary time” for the organisation and the state of North Carolina. North Carolina pioneered a public Medicaid managed care system for behavioral health and intellectual/developmental disabilities in 2011. Next year, the state will move to an integrated healthcare approach for all individuals who rely on the public system for care. “We are right in the middle of developing and introducing many things that no one else has previously done before or even considered in terms of the way in which managed healthcare services are provided. In doing so, we are leveraging the very latest and most innovative technologies that will position us as a true leader in managed healthcare, both in North Carolina and beyond.”
Gianna is responsible for leading Partners’ digital transformation. He sits as a member of the Partners Operational Leadership Team, and rather succinctly describes his work as “trying to understand the organisation’s strategic targets based on the information and direction we get from the North Carolina General Assembly and North Carolina Department of Health and Human Services; while finding the right tools to fit and to meet those requirements.” In reality, Gianna is charged with strategic planning, leading mission-critical business initiatives and organisational objectives, and driving change that will result in improved customer service and go a long way towards achieving better healthcare provision for the population of North Carolina.
Partners is a public, regional managed care organisation, overseeing mental health, substance use disorder and intellectual and developmental disability (I/DD) services available through Medicaid, state and county funding. The organisation, Gianna explains, contracts with care providers to ensure that treatment options are available for eligible residents across the state. “North Carolina is a large state,” he says. “The population is close to 11 million, and one in every 10 is eligible for publicly-funded behavioral and I/DD managed care. However, the system currently in place focuses on a portion of a person’s wellbeing, instead of the whole person, which is a big driver behind our transformation.”
The purpose of Partners’ digital transformation, explains Gianna, is a focus on understanding the overall health and healthcare needs of specific populations through leveraging technologies such as procurement platforms, predictive analytics tools, and the integration of the organisation’s services network so that it can manage the right services at the right time for its health plan members. “First and foremost, we recognise that we need to be very agile and mobile,” he notes. “The first target was driven from a population health and predictive analytics perspective, which focused on understanding what our total cost of care looks like, what do the state’s population and demographics look like, and how that fits into the wider financial and health strategies that we have. Having the ability to really get our arms around that data and turn it into something useful, meaningful and with real purpose had to be the first step.”
To do this, two years ago, the organisation moved to the cloud – specifically, Office 365 – so that, at any place and at any time, anyone within Partners’ executive team could access all the data and information. The transformation journey is still ongoing, with Gianna outlining steps two and three, as well as a longer-term vision. These steps include “sourcing a trifecta of procurement management tools, including tools for population health and predictive analytics that can create health risk scores, as well as portals for users and a platform that allows integration across North Carolina’s ‘healthcare universe’. We have been able to find and apply all the tools we need,” he states. “We are in the process of implementing them – the first ‘finishing line’ is imminent.”
The scale of change within the state has placed North Carolina at the forefront of healthcare reform which, according to Gianna, “is what everyone is trying to achieve. The whole purpose – initially – is to collect and analyse as much data as possible, to really be able to understand exactly what the costs involved are and to ensure that every member can be cared for to the very best standard. That target is phenomenal, and if we pull it off it will be huge.”
Somewhat understandably, such change has required a significant realignment of structure and resources internally. This, says Gianna, hasn’t been easy and has proved a challenge at times. “We’re an organisation that, for some years, has had a lot of processes. We haven’t used specific tools and systems and have required people to really get on board with the new tools and understand the scope of the change. It’s all about introducing a new perspective. It is, after all, a fundamental aspect of being human: you either change and progress, or you don’t. Of course, it helps to know that the end-goal of our transformation is to achieve something truly good for many people. Working in healthcare and understanding the impact on the families we serve definitely changes the way in which you approach your work. Everyone on my team could go and work in other places and quite easily be very comfortable, but we’d never have the same sense of satisfaction that we get from helping people’s lives. That’s what matters the most.”
As with any transformation journey, there is still a lengthy road to travel for Partners. The organisation is on the cusp of achieving significant change yet, for Gianna, other technologies could also come into play in the future. “I’m already considering how we could use AI and machine learning for managing and analysing our data, for example. As we move through our journey, we will collect so much data. We are already focused on how we really leverage the technologies available to provide the best possible answers for that data. There is still a great deal to do but, looking further ahead, I would love to be able to collaborate with other organisations and to share the lessons learned so we can deliver the very best standards of care.”
Concentrating on continuing to reduce future morbidity and mortality, and really giving people healthy life years, remains our key strategic focus.